A Case of Multiple Myeloma Diagnosed by Skin Lesions

Multiple myeloma, being a malignant proliferation of plasma cells in the bone marrow, has clinical spectrum varying from monoclonal gammopathy with unknown significance to plasma cell leukemia. The presenting symptoms have usually been bone pain, pathologic fractures or repeating infections. In patients with multiple myeloma, amyloid depositions may be seen in the skin. This form, defined as primary systemic amyloidosis, is characterized by light-chain amyloid fibril depositions. Our case applied with multiple, asymptomatic, yellowish papules localized on the face, trunk, oral and genital mucosa, gradually increasing during the last two years. He had no complaints, except for slight weight loss. In routine tests, the patient had no pathological laboratory findings, except high C-reactive protein levels. Further research revealed histopathologic and immunohistochemical findings consistent with amyloidosis. Upon these results, immunoglobulin G levels were measured and found high, and in protein electrophoresis, IgG monoclonal gammopathy was determined. The diagnosis of multiple myeloma is made by bone marrow biopsy. This patient is presented for being an asymptomatic case diagnosed by skin findings of amyloidosis

Is mean platelet volume associated with the angiographic severity of coronary artery disease?

Background: Platelet activation and aggregation play key roles both in the pathogenesis of atherosclerosis and in the developmentof acute thrombotic events. Platelet volume is a marker of platelet activation and function, and is measured usingmean platelet volume (MPV).Aim: To determine the relationship between MPV and angiographic Gensini and SYNTAX scores, which give informationabout the severity and complexity of coronary artery disease (CAD).Methods: This study included 435 consecutive patients undergoing elective coronary angiography. The complete blood countand biochemical examination of blood were obtained after 12 h of fasting. The independent association between MPV andthe severity of CAD was statistically evaluated using PASW Statistics 18 for Windows.Results: Mean age of the study population was 58.4 ± 9.3 years, of whom 196 were female (45.1%) and 239 male (54.9%).Of the patients, 63.2% had CAD, 31.7% had diabetes mellitus, 61.8% had hypertension, 56.6% had hyperlipidaemia, and38.6% were smokers. Mean Gensini score was 20.7 ± 31.1. According to Gensini scores, 160 of the patients (36.8%) hadnormal coronary arteries (Gensini score: 0), 134 of the patients (30.8%) had minimal CAD (Gensini score: 1–19), and 141 ofthem (32.4%) had severe CAD (Gensini score ? 20). Mean MPV values were 8.4 ± 1.0 fL in the group that had no CAD,8.7 ± 1.0 fL in the group with minimal CAD, and 9.3 ± 1.5 fL in the group with severe CAD. According to Spearman correlationanalysis, the positive relationship found between MPV and Gensini score was statistically significant (p < 0.001,r = 0.290). Likewise, SYNTAX score was also associated with MPV (p < 0.001, r = 0.504).Conclusions: We determined a positive correlation between MPV and Gensini and SYNTAX scores. Therefore, this simplehaematology test can be used in determining cardiovascular disease burden besides other risk factors during routine clinicalpractice. For further information about this topic, large-scale studies are needed

Role of inflammatory markers in decreasing negative appendectomy rate: A study based on computed tomography findings

BACKGROUND: This study aimed to investigate the role of inflammatory markers in decreasing negative appendectomy rate (NAR) based on their relation with findings of acute appendicitis (AA) on computed tomography (CT). METHODS: Ninety-two patients who underwent CT examination with suspected AA were included. We investigated the relation between CT findings of AA and laboratory inflammatory markers and also performed receiver operating characteristic (ROC) analysis to calculate cut-off values of inflammatory markers and CT findings of AA. Appendectomy cases were re-evaluated considering cut-off values to make the operation decision and NAR was recalculated. Chi-squared test was used to compare the actual and recalculated NAR. RESULTS: Cut-off values of appendiceal diameter, appendiceal wall thickness, and caecal wall thickness were 7.9, 2, and 2.3 mm, respectively, for the diagnosis of AA. Cut-off values of WBC , NLR, and CRP on ROC analysis were 7.47, 4.06 and 13, respectively, for the diagnosis of AA. When the actual and recalculated NAR (21.9% versus 9.1%) were compared, the difference was found to be almost significant (p=0.058). CONCLUSION: Inflammatory markers are not sufficiently powerful on their own to accurately diagnose AA. However, particularly in equivocal cases, proposed cut-off values may be helpful for accurate diagnosis and a lower NAR can be achieved

The role of attention on the intelligence test scores of patients with attention deficit hyperactivity disorder

In comparison to healthy children, cases with Attention Deficit Hyperactivity Disorder (ADHD) score lower at subtests of Wechsler Intelligence Scale for Children-Revised (WISC-R). According to the research hypothesis, the lower scores in subtests of WISC-R originate from disordered attentional processes. Sample (age range: 72-149 months) included 143 healthy boys and 215 boys in the ADHD group (Predominantly Attention Deficit: n = 72, Predominantly Hyperactivity/Impulsivity: n = 41, Combined: n = 102). Participation was conditional to informed consent of the parents and approval of the participants/cases. Cases with comorbidity and medication were not included in the DEHB group. Intelligence was measured using WISC-R, types of attention were measured using Stroop Test TBAG version, Cancellation Test and Visual Aural Digit Span Test-B Form. In line with the types of attention that they represent, neuropsychological test scores loaded on three different factors. Except the digit span score, WISC-R scores loaded on a fourth factor. Scores of the DEHB group was significantly lower than that of the healthy control group in 9 out of 12 WISC-R scores. When types of attention were statistically controlled, 7 of the previously significantly different scores ceased to exist. These findings show that the lower scores of the DEBB group in subtests of WISC-R should not be explained by deficits in the cognitive processes that the subtests specifically intend to measure. These findings support the hypothesis that the lower scores are due to a basic inability to attend and are thus secondary to this disorder

Comparison of blind intubation via supraglottic airway devices versus standard intubation during different airway emergency scenarios in inexperienced hand Randomized, crossover manikin trial

Background: Securing the airway and enabling adequate oxygenation and ventilation is essential during cardiopulmonary resuscitation (CPR). The aim of the study was to evaluate the success rate of blind intubation via the I-Gel and the Air-Q compared with direct laryngoscopy guided endotracheal intubation by inexperienced physician and to measure time to successful intubation. Methods: The study was designed as a randomized, cross-over simulation study. A total of 134 physicians, from specialties other than Anesthesia or Emergency Medicine, who considered themselves skilled in endotracheal intubation but who have never used any kind of supraglottic airway device performed blind intubation via the I-Gel and Air-Q and direct laryngoscopy guided endotracheal intubation in 3 randomized scenarios: normal airway without chest compression during intubation attempt; normal airway with continuous chest compression during intubation attempt; difficult airway with continuous chest compression. Results: Scenario A: Success rate with initial intubation attempt was 72% for endotracheal intubation, 75% in Air-Q, and 81% in I-Gel. Time to endotracheal intubation and ease of intubation was comparable with all 3 airway devices used. Scenario B: Success rate with the initial intubation attempt was 42% for endotracheal intubation, compared with 75% in Air-Q and 80% in I-Gel. Time for endotracheal intubation was significantly prolonged in endotracheal intubation (42seconds, 35-49), compared with Air-Q (21seconds, 18-32) and I-Gel (19seconds, 17-27). Scenario C: The success rate with the initial intubation attempt was 23% in endotracheal intubation, compared with 65% in Air-Q and 74% in I-Gel. Time to intubation was comparable with both supraglottic airway devices (20 vs 22seconds) but was significantly shorter compared with endotracheal intubation (50seconds, P <.001). Conclusions: Less to moderately experienced providers are able to perform endotracheal intubation in easy airways but fail during ongoing chest compressions and simulated difficult airway. Consequently, less to moderately experienced providers should refrain from endotracheal intubation during ongoing chest compressions during CPR and in expected difficult airways. Supraglottic airway devices are reliable alternatives and blind intubation through these devices is a valuable airway management strategy

Evaluation of paradoxical vocal cord motion and differential diagnosis

[No Abstract Available

INTERACTION BETWEEN ACADEMIC RESILIENCE AND ACADEMIC ACHIEVEMENT OF TEACHER TRAINEES

This study sought to explore the interaction between academic resilience and academic achievement as measured by Grade Point Average (GPA). To this end, the Academic Resilience Scale (Cassidy, 2016) consisting of 30 items and scored on a 5-point Likert scale was administered. The overall reliability of the scale was .79 and the reliability coefficients for the three sub-scales were above .70. Student GPAs (M= 2.50, SD= .51) were procured by a self-report item. The sample of the study consisted of 198 preservice English language teachers at a foundation university in Turkey. Descriptive results showed that participants scored highest on reflecting and adaptive help-seeking (M= 3.77, SD= .58). It was followed by perseverance (M= 3.44, SD= .41) and negative affect and emotional response (M= 2.90, SD= .69) dimensions. Moreover, positive correlations were revealed between GPA and perseverance (r= .20, p &lt;.05) and reflecting and adaptive help-seeking (r= .37, p&lt;.01). The results of the multiple regression analysis manifested reflecting and adaptive help-seeking to be the only significant predictor of GPA

PPI kullanımının clostridium difficile serum antijen değerlerine olan etkisi

Aim: To evaluate the effects of proton-pump inhibitor (PPI) use on distrubtion of intestinal flora by measuring serum Clostridium Difficile antigen levels before and at the end of a three- months treatment in patients with Laryngopharyngeal reflux (LFR) treatment. Material and Method: The study covers 32 patients with LFR, out of which 24 were female (75%) and 8 were male (25%). The mean age of the patients was 34.13 +/- 11.59. All patients included in the study were administered Lansoprazole 30 mg tablets perorally before meals and twice a day for treatment. Reflux Symptom Index (RSI), Reflux Finding Score (RFS), white blood cell count, CRP and serum Clostridium Difficile toxin A, B measurement results were comparatively evaluated through the blood serum samples drawn from the patients before and at the end of the three- months treatment. Results: While the mean values of pre-treatment RSI and RFI were 20.81 +/- 4.05 and 13.31 +/- 3.30 respectively, the mean values were measured to be 3.41 +/- 2.37 and 1.50 +/- 1.88 respectively following the three- months treatment (p< 0.05). The pre-treatment mean value of serum Clostridium Difficile Ag was 140.56 +/- 11.74, while it was seen that the same value became 114.94 +/- 10.70 after the three- months treatment (p< 0.05). There was, however, no statistically significant change in the other parameters. Discussion: According to the results obtained, it was seen that the treatment with PPI was not cause to increase Clostridium difficile toxin A, B serum antigen levels. So these drugs could be used in long time therapies confidently.Amaç: Larengofarengeal Reflü (LFR) hastalığının tedavisi amacıyla Proton pompa inhibitörü (PPİ) kullanan hastalarda tedavi öncesi ve üç aylık tedavinin sonunda serum Clostridium Difficile antijen miktarı ölçülerek PPİ kullanımının serum Clostridium Difficile serum antijen miktarı üzerindeki etkisinin değerlendirilmesi. Gereç ve Yöntem: Çalışmaya LFR hatalığı tespit edilen 32 hasta ( 24 ( % 80)’ü kadın, 8 (% 20)’i erkek) dahil edildi. Hastaların yaş ortalaması 34.13 ± 11.59 idi. Çalışmaya dahil edilen tüm hastalara tedavi için günde iki kez yemeklerden önce alınacak şekilde lansoprazol 30 mg tablet peroral olarak başlandı. Tedavi öncesinde ve üç aylık tedavinin sonunda hastaların LFR şiddeti Reflü Semptom İndeksi ( RSI) ve RBS ( Reflü Bulgu Skoru) kullanılarak değerlendirildi. Ayrıca hastalardan tedavi öncesi ve üç aylık tedavinin sonunda alınan kan serum örneklerinde beyaz küre, CRP, sedimantasyon ve serum Clostridium Difficile toxin A, B ölçümleri yapılarak karşılaştırmalı olarak değerlendirildi. Bulgular: Tedavi öncesi RSI ve RBS ortalamaları sırasıyla 20.81±4.05 ve 13.31±3.30 iken, üç aylık tedavi sonrasında bu ortalamalar sırasıyla 3.41±2.37 ve 1.50±1.88 olarak tespit edildi ( p< 0,05). Tedavi öncesi serum Clostridium Difficilie Ag değerlerinin ortalaması 140.56±11.74 iken üç aylık tedavi sonrasında bu ortalamanın 114.56±10.70 olduğu görüldü ( p 0,05). Tartışma: Elde ettiğimiz sonuçlara göre, proton pompa inhibitörü kullanan hastaların Clostridium difficilie toxin A, B serum antijen düzeylerinde istatistiksel olarak anlamlı bir düşüş olduğunu görüldü

Kardiyotorasik dışı cerrahilerde postoperatif pulmoner komplikasyonlar

Purpose: Postoperative pulmonary complications (PPCs) are a major cause of mortality and morbidity. The aim of this study is to evaluate frequencies and determine risk factors of PPCs which developed subsequent to general surgery and orthopedic surgery in a tertiary university hospital.Materials-methods: Patients who were operated in Departments of General Surgery and Orthopedics and Traumatology were retrospectively included to the study.Results: 683 patients with a mean age of 59.43±18.77 years were included in the study. The ratio of PPC was 10.3%. Most frequent PPC was found to be pneumonia (6.3%). The prevelance of PPC was significantly higher in patients ?65 years than who were 4 h) were respectively as follows 2.8%, 9.5%, 25%, 75% and 100% (p<0.001). Multivariable logistic regression analysis showed that being ?65 years, having ASA?3 and hypoalbuminemia (<3g/dl) were independent risk factors for development of PPC (OR:2.45, 95% CI (1.14-5.25) p<0.05; OR: 44.5, 95% CI (5.13-386.1) p<0.05; OR:6.4, 95% CI (3.14-13.1) p<0.05).Conclusion: The clinicians should be aware of PPCs especially in patients who were ?65 years, had ASA?3 and hypoalbuminemia (<3g/dl)Amaç: Postoperatif pulmoner komplikasyonlar (PPK) önemli mortalite ve morbidite sebebidir. Çalışmamızın amacı ortopedi ve genel cerrahi operasyonlarından sonra gelişen PPK sıklığını ve risk faktörlerini belirlemektir. Gereç ve yöntem: Genel cerrahi, ortopedi ve travmatoloji kliniklerinde opere edilen hastalar retrospektif olarak değerlendirildi. Bulgular: Ortalama yaşı 59,43±18,77 yıl olan 683 hasta çalışmaya alındı.PPK %10,3 idi. Pnömöni (%6,3) en sık görülen PPK olarak tespit edildi. PPK sıklığı 65 yaş ve üstünde altında göre belirgin olarak yüksek saptandı. (%18,2 vs %4,4) (p<0,001). Acil cerrahi operasyonlarda elektif operasyonlara göre daha sık tespit edildi (%24,1 vs %8) (p4st) PPK gelişim oranı sırasıyla %2,8, %9,5, %25, %75 ve %100 olarak bulundu (p<0,001). Çok değişkenli logiistik regresyon analizine göre ASA≥3, hipoalbunemi (<3g/dl) ve 65 yaş üstü PPK gelişiminde bağımsız risk faktörü olarak saptandı (OR: 2,45, %95 CI (1,14-5,25) p<0,05; OR: 44,5, %95 CI (5,13-386,1) p<0,05; OR: 6,4, %95 CI (3,14-13,1) p<0,05). Sonuç: Klinisyenler preoperative değerlendirmede ASA≥3, hipoalbunemi (<3g/dl) ve 65 yaş üzerindeki hastalarda PPK açısından dikkatli olmalıdır

Abnormal foot angles has an association with ingrown toenail

Background: Onychocryptosis, frequently termed ‘‘ingrown toenail’’ is a common foot problem in routine dermatology and orthopaedic clinical practice which leads to pain and disability. Although the aetiology of ingrown toenail is not well understood various associated risk factors have been identified with the pathogenesis. Material and methods: This study was a retrospective investigation of 170 patients with hallux valgus and lateral border ingrown toenail of all stages. The patients were compared with a control group. The radiologic assessment in both groups included right hallux valgus angle, left hallux valgus angle, right first and second intermetatarsal angle, and left first and second intermetatarsal angle. Results: There were 121 female and 49 male patients in the case group and 68 female and 32 male in the control group. The mean age of the case group was 41.1 years and 41.1 years in the control group. A statistically significant difference was found between the case and the control groups in terms of the right hallux valgus angle variable. Conclusion: The abnormal hallux valgus angle and the abnormal intermetatarsal angle plays an important role in ingrown toenail aetiology. The X-rays of the feet should be performed to determine the susceptibility of the patients who are admitted to the hospital for ingrown toenail in order to prevent other toes ingrown toenail and for planning the treatment of the patients with an ingrown toenail